Improving Patient Care and Clinical Services: Compliance With the British Orthopaedic Association Standards for Trauma (BOAST) Guidelines for Neurological and Vascular Assessment of Acute Fractures

TL;DR

This study shows that educational interventions can improve documentation of neurological and vascular assessments in patients with acute fractures, aligning with BOAST guidelines.

Contribution

The study demonstrates that targeted education within a closed-loop audit improves compliance with trauma assessment guidelines.

Findings

NV documentation improved from 87.8% to 97.9% after an educational intervention.

Vascular recording became statistically significant, rising from 26.5% to 45.8%.

Many records still used the vague term 'NV intact' despite improvements.

Abstract

Introduction

Traumatic limb fractures risk neurovascular (NV) compromise and require documented nerve-specific sensory, motor, and arterial assessments to support early detection and management. The British Orthopaedic Association Standards for Trauma (BOAST) mandate clear documentation of peripheral nerve function after injury, manipulation, cast fitting or surgery. This closed-loop audit measured current practice against the December 2021 BOAST guideline and tested whether a targeted educational intervention could improve NV documentation.

Methods

An audit for service evaluation and quality improvement at Russell Hall Hospital, UK, reviewed 97 adults admitted with acute upper- or lower-limb fractures across two cycles (49 patients, January 2024; 48 patients, July 2024). A single educational awareness presentation took place in May 2024. Data were extracted from Trauma & Orthopaedic (T&O) admission notes and benchmarked against BOAST criteria requiring specific nerve and arterial status. Median age and interquartile range (IQR) were reported; categorical comparisons used Pearson’s χ², and effect size was reported as phi (φ). Significance threshold was p < 0.05.

Results

Median age was 64 years (IQR: 34.5-79.5). The use of NV documentation rose from 87.8% to 97.9% following the intervention (χ² = 3.74, df = 1; p = 0.053). Detailed neurological recording increased from 38.8% to 54.2% (χ² = 2.31, p = 0.129; φ = 0.154). Detailed vascular recording improved from 26.5% to 45.8%, reaching statistical significance (χ² = 3.92, p = 0.048; φ = 0.201). Many entries continued to use the nonspecific phrase 'NV intact' rather than specific details.

Conclusion

Educational sessions within a closed-loop audit framework improved completion of an NV assessment and a significant rise in vascular details, while neurological details showed a slight increase. Continued adherence to BOAST guidance and structured feedback mechanisms should preserve high standards of NV assessment and improve patient safety.